New HIV Epidemic Looms over Romania

WARSAW, Nov 27 2012 (IPS) - New HIV infections among Romanian drug users have grown exponentially over the past couple of years, from three to five cases annually between 2007 and 2009, to 98 just in the first half of 2012.

The year 2011 saw 129 new cases of HIV among injecting drug users after 12 new cases had been registered in 2010. Injecting drugs has now become the second most common way to contract the virus in Romania (the first is heterosexual transmission), after being a negligible cause of infections for most of the post-socialist period.

International and national groups working for HIV prevention expect the emerging epidemic to expand over the next years, despite causes for the rise in cases being relatively easy to pin down.

For one, there has been a significant change in drug consumption patterns. In Romania, the vast majority of injecting drug users live in capital Bucharest. There were over 19,000 so-called problem drug users (who inject drugs or regularly use opioids, cocaine or amphetamines) in the city in 2010, in a total population of almost two million.

Bucharest users had been traditionally injecting heroin but have more recently switched to amphetamine-type stimulants – mostly synthetic cathinones such as mephedrone. In 2009, 97 percent of users reported heroin as the main drug of injection; in 2010 already 30 percent of users were injecting synthetic amphetamines.

Since 2008, Romania has seen a boom in the market for legal highs. While the authorities were struggling to understand the phenomenon and outlaw the synthetic substances one by one, numerous injecting users had switched already from heroin to the new drugs because of the perceived safety behind their legality and easier availability. A ‘heroin drought’ hitting Europe in 2010 because of lower opium production in Afghanistan may have played its indirect role as well, though causality is difficult to establish.

The injecting synthetic drugs available on the Romanian market require on average twice as high frequency of injection as heroin, meaning that users need more syringes and are likely to share more.

Importantly, while this change was happening on the drugs market, the number of syringes distributed through needle exchange programmes halved between 2009 and 2010 and remains low to date. In 2009, organisations working with drug users distributed 1.7 million syringes to Romanian users, while in 2010 only 965,000 were given out. According to the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), 3.6 million syringes would be needed in Bucharest only to keep the risk of infectious diseases spread low.

In Romania, needle exchange programmes were set up and funded by international donors such as the United Nations, the Global Fund (to Fight AIDS, Tuberculosis and Malaria), or the Open Society Foundation. But as Romania started to be categorised as a better off country by donors, foreign funds dried up. For instance, the halting of grants from the Global Fund in 2010 was directly related to Romania’s being classified as an upper middle income country by the World Bank.

European Union regional funds, still used by local NGOs for some programmes, reportedly come with bureaucratic burdens often too big. For one, groups accessing these funds say that administrative tasks keep staff away from social work on the ground; additionally, disbursement of these EU funds requires submitting personal data of the beneficiaries, which may deter some users from seeking help in a country where drug use is heavily criminalised.

While international funding is getting increasingly harder to access, Romanian authorities are not stepping in to fill the gap.

The Romanian Ministry of Health is at the moment in charge of detoxification programmes in the country. The Ministry and the National Anti-Drug Agency also run in total seven opiate replacement centers across the country, which handle around 1,200 patients; in 2011, in Bucharest, only 9 percent of injecting drug users were covered by the available opiate treatments. However, authorities have so far failed to recognise the importance of financing syringes.

“The spike in HIV in Romania demonstrates a troubling dynamic we are expecting to see across Central and Eastern Europe, which is the withdrawal of international support for HIV programmes without any assurance that national governments will pick up the slack,” says Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundation.

“There was a fantasy that EU accession would help ensure the same kind of health protection and social support in countries like Romania that the richer EU countries have,” Wolfe told IPS. “But while some small support for programmes for drug users have come from EU social funds, these have been inadequate to the need and excluded support for the sterile injection equipment that is the core of HIV prevention efforts.”

Neither the Ministry of Health nor the Municipality of Bucharest, which share responsibility for HIV prevention among and care for drug users in Bucharest, responded to requests from IPS to comment on how they plan to deal with the emerging epidemic.

According to Valentin Simionov from the Romanian Harm Reduction Network, an advocacy group working on HIV prevention and care, while HIV prevention policies in place in Romania look well on paper, implementation has been disastruous.

“Romanian authorities are ignoring public health,” says Simionov. “When they say that they do not have money for needle exchange programmes, we would rather answer that this is a case of bad management of public resources.

“We have estimated that it would cost the Romanian state four million euros annually to fully support needle exchange programmes covering 9,000 injecting drug users, from purchase of syringes to their safe disposal,” Simionov told IPS. “It’s common knowledge that this is the price that the Romanian state pays for one kilometre of highway in some cases, so how can they say the money does not exist? In reality, it is all a matter of setting the right priorities.”